Abstract P060: A Retrospective Review of Pediatric Hypertension Management in a Hypertension Referral Clinic
Introduction: High blood pressure (BP) in childhood increases the risk of adult hypertension, cardiovascular disease, kidney disease, and premature mortality. Additionally, hypertensive children are more likely to display other cardiovascular risk factors. Though guidelines for hypertension management exist, there is little published insight from clinical practice, and selection of the appropriate pharmacologic therapy for a child is often difficult for health care providers. The University of Mississippi Medical Center Hypertension Clinic is a referral center for pediatric hypertension management. The purpose of our study was to define characteristics of this clinic’s pediatric population, including modalities of hypertension management, the presence of concurrent disease states, and response to treatment.
Methods: Records of patients ages 1-17 years presenting to the clinic over a 3-year period were reviewed (N=374). Patients with only one clinic visit or without a diagnosis of hypertension or an elevated BP at the initial visit were excluded. Data collected included demographics; initial and last recorded height/weight and BP; baseline medications and changes; laboratory or test documentation; and presence of concurrent disease states. BP was classified and staged as normal, prehypertension, stage 1 hypertension, or stage 2.
Results: Patients included were 69% (132/191) male and 67% (128/191) African American, with a mean age of 12.46±3.44 years. The majority of patients were obese at initial visit (62%,118/191), with an additional 12% (23/191) classified as overweight. The mean BP of patients on antihypertensive medications (37%,71/191) at clinic entry was lower than those untreated, 127±15/77±12 versus 133±13/79±11 mm Hg, respectively. At final review, 67% (128/191) were on antihypertensives (40%,76/191 - one medication; 23%,43/191 - two; 5%,9/191 - three or more). Angiotensin converting enzyme inhibitors (ACEIs) were most frequently prescribed (43%, 82/191) by the clinic, followed by calcium channel blockers (CCBs, 32%, 61/191), and diuretics (20%,39/191). Common concurrent disease states were ADHD (12%,23/191) and asthma (9%,18/191). Though 61% (117/191) had BP controlled at the last visit reviewed compared to 41% (78/191) at clinic entry, there was no correlation between BP control and length of follow-up. Both initial systolic and diastolic BP stage appeared to influence the timing of medication initiation (OR=2.4, p<0.001).
Conclusion: Our results identify that most children in our clinic with hypertension are obese and require medications for BP control, similar to adult populations. ACEIs are the most common medication class used for management, followed closely by CCBs. Systolic and diastolic BP, specifically at the level of stage 2 hypertension, was found to strongly influence medication initiation at initial visit.
Author Disclosures: D.S. Minor: None. L.T. Cadwallader: None. Z.K. Henson: None. K.A. Carbrey: None. K.R. Butler: None.
- © 2014 by American Heart Association, Inc.